HomeMy WebLinkAboutDeRidder, Brian ,IO %VV$ufFO��-co
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ELIZABETH A.NEVILLE ��_� Gy�t• Town Hall, 53095 Main Road
TOWN CLERK ; y = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Pr, t Southold, New York 11971
MARRIAGE OFFICER .f� �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �_'4O,( ��0�•�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ r►�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2441 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GREENBRIAR HOMES INC
Address 1 : 59 HAWXHURST ROAD
City St Zip COLD SPRING HARBOR NY 11724
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF # R10-00-0222
Name Of Owner BRIAN & SUSAN DERIDDER
Mailing Address 1 14005 ROUTE 25
City St Zip MATTITUCK NY 11952
Property Address 1 OLD FIELD COURT
City St Zip MATTITUCK NY 11952
Tax Map No. section 120.00 block 3 lot 8.019
Cross Street FRAMVEU ROAD
Building Permit Number Cross Reference:
Issue Date: 10/30/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE 1�0 P �V: Town Hall, 53095 Main Road
TOWN CLERK ; y% Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS $� Southold, New York 11971
MARRIAGE OFFICER �� y �`ft/ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _doljig $ ,ll' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 24, 2000
Transmitted herewith is a copy of application No. 2529 for a Cesspool/Septic Tank Construction
Permit submitted by:
Greenbriar Homes Inc
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
8'9 - S(''' --"-`
ignature
Dated
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OFFICE OF THE TOWN CLERK � C�� Ur n -_ C
TOWN OF SOUTHOLD �' 7�l 6QG= Application No.49?
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ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971
z. ^ Alteration
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Telephone ,y �O. $10.00 - Residential
(516) 765-1801 ==?�1 ,, $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION tope
for re `�►�o►tv
CONSTRUCTION or ALTERATION PERMIT (14, / l�0
�O
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: 6 4'/2J/72 1/7-1:024_S' /A"=-
APPLICANT ADDRESS: /G' hi/40,4 /9/1/2-f7"
SEPTIC )C* CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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Tit i4 72C
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
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OWNER OF PROPERTY: / SA)
OWNER MAILING ADDRESS: /440,0.S.-- 01.1.7""
/72,97-7-;-aC / N'/ //9sz-
OWNER PROPERTY ADDRESS: 04.I)/ /62-6, '2J'/
�//O / 4'2'i�U`,� A49-6 /MAL- "-VC
TELEPHONE NUMBER OF CONTACT PERSON: (o )
TAX MAP NO. : Section /,2 Block (2 Lot of/9
CROSS STREET: , 719è
BUILDING PERMIT NUMBER CROSS REFEREN E:
d7)?1,1-- t,&et-W 1%24.2--
Signature of Applicant
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RECEIVED BY :
Town Clerk's Office
DATE:
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RTMENT OF HEALTH SIEt:•VN.:Es
SUFFOLK COUNTY DEPA --------------------
PERMIT FOR APPROVAL OF CONSTRUCTION FORA
SINGLE FAMILY fiE:^.IrCNCZ ONLY
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Ae",,,,,,0„wie,4/4--,./n,,c/za::)frw,47. unauthorized alteration or addition .
0..ero-xee.e.gA,/ ti ,pke) pe-,49.p.494e ZAA/P 1.).e.1/4"Yeae to this survey is a violation of
ea-t 4 ) Section 7208 of the New York State
Re), l . , .
Z071/2'/14.4447,0, -/ 4-n414°' , !..,777'seg/( • Education Law
Copies of INs survey map not bowing
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//47 7/ the land suneyors Inked seal or
IG.C.49-Ar24.4frif.9717,1X-Xi7b 'A/0,4rA/ar/reV.40/4,/, >4 ,
embossed au shall not be considered
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to be a%laid vu.copy.
Guaranties Indicated hereon shall run
only to the person for whom the survey
Is prepared,and on his behalf to the
tide company governmental agency end '...
lending institution listed hereon and
to the assignees of the lending Institution.
Guarantees are not transferable
to additional Institutions a subsequent
owners.
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